Chest. 2014 May 15. [Epub ahead of print] [Link]

Ahmed A, Corcoran JP, Gleeson FV, Hallifax RJ, Hassan N, Manuel A, Maruthappu M, Nagendran M, Psallidas I, Rahman NM, Rostom H.



Definitive diagnosis of pleural disease (particularly malignancy) depends upon histological proof obtained via pleural biopsy or positive pleural fluid cytology. Image-guided sampling is now standard practice. Local Anaesthetic Thoracoscopy (LAT) has a high diagnostic yield for malignant and non-malignant disease but is not always possible in frail patients, if pleural fluid is heavily loculated, or where the lung is adherent to the chest wall. Such cases can be converted during the same procedure as attempted thoracoscopy to cutting-needle biopsy. This study aimed to determine the diagnostic yield of a physician-led service in both planned biopsies and cases of failed thoracoscopy.


Retrospective review of all ultrasound-guided cutting-needle biopsies performed in Oxford (January 2010 – July 2013). Histological results were assessed for the yield of pleural tissue, final diagnosis and clinical follow-up in non-malignant cases.


50 ultrasound-guided biopsies were undertaken. Overall, 47 (94.0%) successfully obtained sufficient tissue for histological diagnosis. 13 of 50 were biopsies conducted after failed thoracoscopy (5.2% of 252 attempted thoracoscopies over the same time period); of these, 11/13 (84.6%) obtained sufficient tissue. 13/50 (26.0%) demonstrated pleural malignancy on histology (despite previous negative pleural fluid cytology), while 34/50 (68.0%) were benign. Of the benign cases, ten were pleural tuberculosis, two were sarcoidosis and the 22 were benign pleural thickening. There was one “false negative” of mesothelioma (median follow-up of 16 months).


Within this population, physician-based ultrasound-guided cutting-needle pleural biopsy obtains pleural tissue successfully in a high proportion of cases, including those of failed thoracoscopy.